Traditionally-placed shunts for hydrocephalus have a high degree of shunt failure (shunt stops working or infection). There is significant morbidity and some mortality in re-operating on these patients. Another technique to place shunts is endoscopically, and there is some evidence that these shunts have a decreased failure rate. However, this has not been rigorously studied. This study will randomize patients to either endoscopically inserted shunts or shunts placed by traditional surgical means. A total of 433 patients will be enrolled in this randomized study, with 20 enrolled at this site. The primary outcome is time to shunt malfunction.